Agenda item

The Our Healthier South East London briefing presentation enclosed will be

presented by:

·  Julie Lowe, Programme Director – OHSEL STP [Lead Officer]

·  Mark Edginton, Programme Director, Community Based Care – OHSEL

STP

·  Tom Wake, Head of Programme Management Office (PMO) – OHSEL

STP

The following are also enclosed:

·  Our Healthier South East London: Partnership Update

·  Our Healthier South East London: User Stories

·  A glossary of terms used by Our Healthier South East London

The chair asked NHS colleagues to introduce themselves:

·  Julie Lowe, Programme Director – OHSEL STP;

·  Mark Edginton, Programme Director, Community Based Care – OHSEL STP;

·  Tom Wake, Head of Programme Management Office (PMO) – OHSEL STP; and,

·  Andrew Eyres, Accountable Officer, NHS Lambeth CCG & NHS Croydon CCG.

The chair invited NHS colleagues to run through the presentation circulated with the agenda papers. In her introduction, Julie Lowe Programme Director noted that a number of members are new appointees to the JOSC. The presentation was designed to provide an overview of the OHSEL programme, which represents the region’s Sustainability and Transformation Plan (STP) and the JOSC covers the same boundaries as the STP. The Plan is designed to ensure a sustainable future for the NHS in South East London delivering high quality patient care with the best possible outcomes in ways that are affordable. In 2018 the focus is on three key things: (1) Integrated Care Systems; (2) End to End Pathway Work; (3) Provider Collaboration. The Programmed Director set out the headline issues and an update on the programme groups (as set out in the report). The committee was then invited to ask questions. The following issues were raised and responses given:

·  A member questioned on the extent to which NHS England had devolved responsibilities for primary care to CCGs in SEL and therefore if there was a greater opportunity through the STP to look at primary care and reducing pressures on A&Es and admissions. It was confirmed that there is primary care delegation across the whole of SEL. The primary care executive meets together regularly to share best practice and opportunities to do things at scale. Officers advised that a core concept of the Community Care Based Strategy is that primary care comes together in Local Care Networks and look at alternative ways to provide care closer to home, as well as addressing issues around SEL population health more generally.

·  A member sought clarification on the Urgent and Emergency Care Programme and proposals to enhance care in other settings and changing urgent care centres (UCC) into urgent treatment centres (UTC). Officers explained that there is national criteria for UTC, in SEL the NHS is looking at where it can meet that national criteria. It is also important for members of the public to be able to understand what service they can expect in going to a UCC or to a UTC and this accordingly will also help people determine where they should go when seeking treatment. For the public the definitions can be confusing and there is a need for greater clarity and a level of standardisation across SEL. It was acknowledged that some people will automatically go to A&E/UCC without checking on the availability of a GP appointment: pilots are being undertaken at A&E triage which signposts an individual to where they might be more appropriately treated and offered an alternative arrangement/appointment. There was also a need to open up access to GPs more generally and promote wider understanding about GP Hubs and that people can generally get a next day appointment to be seen by a GP, though that may not be their GP.

·  With regard to the status of Orthopaedics and arrangements going forward, officers advised that over a period of 18 months CCGs and providers are looking at whether consistent outcomes can be demonstrated across all current providers, and if that is the case that will be the commissioned arrangement going forward. The focus thus far has been on hip and knee replacements which is high volume work and is looking consistent; there is a however a need to look at lower volume work and whether that is better centralised.

·  A member questioned on Pathology Services and the future of Lewisham & Greenwich services specifically. Officers advised that NHS Improvement has sought the formation of 29 Pathology networks nationally and the recommendation is that SEL forms a network. There is flexibility to join a different geographic network, however arising from specialist advice there is not flexibility for standalone services. A review process has been undertaken across SEL provision and a tender invitation issued to see whether partners are interested in providing the service. It was noted that Kings and Guys & St Thomas’ have been in a joint venture partnership which has a commercial element for approximately ten years. Notwithstanding the status of that contract which is up for renewal, Lewisham & Greenwich are considering the position and interested in exploring the options for being engaged in a purely NHS provision, rather than the potential for being in provision which has a commercial element. It was expected that more would be known in January. However it was not considered that this is an issue around the patient or clinical experience of care.

·  A member questioned the status of Local Care Networks (LCN), their governance and how they are monitored. Officers advised that LCNs are defined in part by historic working arrangements so LCNs across the region are at different stages of development with some at a more mature status than others. Work is ongoing through the STP to share good practice including how to develop the clinical voice, understanding the benefits of being in a LCN, and exploring opportunities for greater partnership working – examples include Federation working or an Alliance model with community and mental health providers. There are 8 LCN across SEL (from 15 previously) and the move is towards larger scale collaborations. Arising from external issues such as financial challenges, patient pressures and NHS reporting requirements General Practices generally are starting to understand the benefits of being in a LCN and managing matters at scale, there is also increasing confidence from the clinical voice of the benefits to patients. Whilst some arrangements only commenced within the last two years, in Lambeth and Southwark there has been GP collaborative working for a much longer period and the learning from those areas have been key to informing the areas which are less developed. GPs value the opportunities to work across different professional groups and interact in multi-disciplinary teams (e.g. involving social workers, pharmacy etc), to support patients who have multiple issues and needs which are difficult to address in isolation. LCNs are about professional networks and delivering better outcomes for patients; they also provide an opportunity to be outward looking and think about populations and health, rather than addressing solely the needs of an individual who attends a surgery.

·  In response to questions on winter pressures and planning, the committee was advised that winter plans are expected to be signed off in the next week arising from work which started in the spring with a debriefing on the previous winter. A lot has been done to educate people about when to attend A&E and alternative options, and this work is ongoing. UTCs can take the pressure off hospital services and are available to patients at weekends. As well as looking at the front end of services, work and testing is also taking place around patient discharge and whether discharge happens in a timely manner. In particular, and reflecting the nature of the regions hospitals and patient flow, there is a focus on whether the offer is working well across the whole of the SEL population and whether management systems and mechanisms for working with social care departments are effective. In response to a suggestion that there needs to be a team for discharging patients, rather than this being managed through each individual borough, officers advised that this is something which is being explored.

·  Further information was sought on the Digital Enabler programme and whether there is an associated policy, where it would impact and timelines. Officers advised that there are a number of work streams underway such as Virtual Care Records where a person’s record can be seen in real time and the One London Programme whereby every record is always available. For health professionals having access to the most current up to date information will mean that patients get the best care and accurate decision making immediately and it will also improve the patient pathways as there will be better join up across services and support systems.

·  In relation to the differential costs and payments associated with a patient going to a GP, to a UCC or to A&E, a member questioned on referral mechanisms from A&E for patients seeming non-urgent treatment. Officers advised that patients attending A&E will be triaged and if the patient does not need to be there the hospital can re-direct and refer to local practice or book into a Hub. However if a patient is not local this is more difficult. There is a balance of risk for clinicians in turning somebody away and a more likely scenario is a short consultation. It was also noted that there are some issues around borough boundaries and using a Hub where a patient is not registered in that borough. Members questioned whether there might not be benefits of cross boundaries in SEL and officers agreed to take back this issue and consider what reciprocal arrangements might work and look like.

In concluding the discussion it was noted that there were no major consultations pending. The following issues were raised by members and officers as potential matters for future scrutiny by the JOSC:

-  Hubs – roll out; public/patient awareness; geographical arrangements and cross boundary;

-  UCC & UTC – people understanding where they should go;

-  Population health, life expectancy and long term planning in SEL (e.g. age pressures in different boroughs);

-  Children and Young People mental health;

-  Residential care beds and access to beds close to home/where families are; and,

-  Integrated care.